Kids' mental health care needs soaring

Demand far outstrips resources

May 5, 2012

Wolf is the Director of Admissions at Lakeland Behavioral Health System, a psychiatric hospital for children. She spends her days fielding phone calls from caseworkers, desperate parents and sometimes even the children themselves to decide who will get care. / Valerie Mosley/News-Leader

Written by

Free forum on Thursday

The Southwest Missouri branch of the National Alliance on Mental Illness and Lakeland Behavioral Health are hosting a free forum on children’s mental health from 10 a.m. to noon Thursday at the Stalnaker unit of the Boys & Girls Clubs of Springfield, 1410 N. Fremont Ave. The program will be include a presentation by Richard Aiken, the medical director at Lakeland Behavioral Health and a discussion of mental health programs for children. For more information or to RSVP, contact NAMI Southwest Missouri at 417-864-7119 or email dlong@namiswmo.com .

More

ADVERTISEMENT

Sara Wolf is the gatekeeper at Lakeland Behavioral Health System, a psychiatric hospital for children. She spends her days trying to decide who will get care, fielding phone calls from caseworkers, desperate parents and sometimes even the children themselves.

She has a script. Has the child made a suicide attempt? Does the child have access to a gun? Is there a history of abuse?

When Wolf arrives at work at 8 a.m., there is usually a handful of beds available. By noon, there are none.

And there’s the phone.

“It rings all day,” said Wolf, the director of admissions and the director of social services. “People will call because their kids are out of control. They don’t know where to turn. If the level of risk is great enough, we will get them.”

The situation at Lakeland mirrors the difficulty statewide, and nationwide, with access to treatment for the most seriously disturbed children. In January, there were 428 psychiatric beds available statewide for children at hospitals, according to the Missouri Hospital Association. Southwest Missouri currently has 135 beds: 66 at Lakeland, 16 at Cox North and 53 at Heartland Behavioral Health Services in Nevada.

In the last seven months, calls to Lakeland have gone up about 22 percent. Child psychiatrists at Mercy Hospital Springfield sometimes have a waiting list of a year. Urban areas like Springfield have more child psychiatrists and draw in patients from across the state.

Missouri had 101 psychiatrists for children and adolescents in 2001, or about 7.1 per 100,000 children, according to a 2006 paper in the Journal of the American Academy of Child and Adolescent Psychiatry. The rate nationally was about 8.7 child and adolescent psychiatrists per 100,000 children.

The demand means that sometimes psychiatric patients in crisis wait for hours in hospital emergency departments until a bed opens up in a psychiatric facility. The Missouri Hospital Association surveyed hospitals in August asking how many patients were “boarded” — held in the emergency room for more than two hours after a decision to admit was made. Hospitals in southwest Missouri reported having 11 patients younger than 21 in that emergency room situation in the week the survey was taken.

“It’s getting harder to access than it used to be,” said Katy Tynes, a child and family therapist who sometimes seeks psychiatric care for her clients. “A lot of these children are Medicaid children with a lot of disruptive family situations. There are fewer and fewer people who take Medicaid, and the ones taking it are the young ones just getting out of school.”

The 1904 building that houses Lakeland was originally Springfield Hospital. Dr. Thomas Ashley performed the first open-heart surgery in Springfield in the 1960s at when the building was Springfield Baptist Hospital. Since 1989, the facility has been a psychiatric hospital. The hospital is owned by Acadia Healthcare of Franklin, Tenn.

Acadia, which took over Lakeland in 2011, is spending at least $3.1 million to remodel the facility. An unannounced four-day inspection by the state in August found safety concerns that included rooms that weren’t adequately designed to prevent patients from harming themselves. Grill covers on the ventilation openings had holes that patients could potentially use to hang themselves, and metal name plate holders outside each patient’s doorway provided the potential for patients to cut themselves.

Keith Furman, the CEO of Lakeland, said he knows of no suicides at Lakeland. He said the remodeling is making the facility safer and bringing an antiquated building up to date.

“We’ve got the latest anti-ligature equipment that you’ll find in any large city,” he said. The “ligature” terms means equipment that children can’t hang themselves from.

Furman said the state reinspected Lakeland in January and it was given a clean bill of health.

“I’m 100 percent transparent,” he said. “If we have a problem or some potential liability, I want it brought to my attention, and we will fix it.”

Children come to Lakeland from all over Missouri and other states including Alaska, Washington and Kentucky. Some fly to Springfield. Others are brought from their homes in unmarked minivans operated by Lakeland.

The children admitted to the acute beds at Lakeland are in crisis. They may have tried to kill themselves or threatened to commit suicide. Some suffer from depression. Others are bipolar. Most are on Medicaid. Children as young as 4 are admitted.

Upon arrival, staffers check the children for weapons. Bathrooms don’t have any exposed pipes that can be used for hanging or self-injury. Each child’s room has a camera. Motion detectors in the rooms are turned on about 9:30 p.m. to try to prevent suicide attempts.

“Basically, if they get out of bed at night it sets off an alarm,” said Nate Duncan, Lakeland’s director of business development. “Any extreme motion in the room sets off an alarm.”

The younger children have stuffed animals for comfort. There is a “time out” room where children can draw or write on walls decorated with chalkboards. Messages from parents adorn the walls.

The patients get up each day at about 6:30 a.m. There is school so the children can try to keep up with their classwork and lots of group therapy. Children attend sessions on family issues, anger management and coping skills. They write in journals and talk about abuse. There is a playground, basketball hoops and a swimming pool.

“The power of the facility is the treatment,” said Richard Aiken, the medical director for the hospital. “It’s very, very intense and thorough. We treat them, not just stabilize.”

A hospital stay can last a few days to a couple of weeks. Medical staffers repeatedly have to justify to the insurance company that the patient needs continuing inpatient care. Children who are discharged are supposed to continue seeing counselor after. Sometimes there are problems with that.

Dayna Harbin, the manager for the child and adolescent unit at Cox North, said even children who have just been discharged from a psychiatric facility can sometimes face a wait of several months to see a child psychiatrist.

“We try to triage the kids because there aren’t enough child psychiatrists to go around,” Harbin said. “If the child doesn’t have multiple diagnoses and only has an antidepressant as opposed to multiple meds maybe we’ll see if they can work with their primary care doctor.”

After Wolf leaves Lakeland at the end of each day, the calls for help continue. Lakeland has a 1-800 number for people with children in crisis.

Wolf awaits the challenges of the next day — and the day after that and all the days after that, deciding which of the children should get care.